Matzim LA 180mg Tablets
It is used to treat high blood pressure.It is used to treat some types of chest pain (angina).It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihypertensive, Antianginal
Pharmacologic Class
Non-dihydropyridine Calcium Channel Blocker
Pregnancy Category
Category C
FDA Approved
Mar 2007
DEA Schedule
Not Controlled
Overview
What is this medicine?
Matzim LA is a medication called a calcium channel blocker. It works by relaxing blood vessels and slowing your heart rate, which helps to lower your blood pressure and reduce chest pain (angina). It's a long-acting tablet, meaning you usually take it once a day.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. When taking your medication:
Swallow the tablet whole without chewing, breaking, or crushing it.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start feeling well.
Storing and Disposing of Your Medication
To maintain the quality and safety of your medication:
Store it at room temperature, protected from light and moisture.
Keep it in a dry place, away from the bathroom.
Store all medications in a secure location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of medications, and consider participating in local drug take-back programs.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However:
If it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. When taking your medication:
Swallow the tablet whole without chewing, breaking, or crushing it.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start feeling well.
Storing and Disposing of Your Medication
To maintain the quality and safety of your medication:
Store it at room temperature, protected from light and moisture.
Keep it in a dry place, away from the bathroom.
Store all medications in a secure location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of medications, and consider participating in local drug take-back programs.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However:
If it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take the medication exactly as prescribed, usually once daily at the same time each day.
- Swallow the tablet whole; do not crush, chew, or divide it.
- Avoid consuming grapefruit or grapefruit juice while taking this medication, as it can increase the amount of diltiazem in your body.
- Maintain a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as recommended by your doctor.
- Limit alcohol consumption.
- Do not stop taking this medication suddenly without consulting your doctor, as it can worsen your condition.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
180 mg once daily
Dose Range:
120 - 540 mg
Condition-Specific Dosing:
hypertension:
Initial 180-240 mg once daily; may titrate up to 540 mg once daily based on response.
chronicstableangina:
Initial 120-180 mg once daily; may titrate up to 480 mg once daily based on response.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended, monitor closely.
Moderate:
Use with caution, monitor for exaggerated effects.
Severe:
Use with caution, consider lower starting doses and careful titration.
Dialysis:
Diltiazem is not significantly removed by dialysis; use with caution, monitor for effects.
Hepatic Impairment:
Mild:
No specific adjustment recommended, monitor closely.
Moderate:
Use with caution, consider lower starting doses and careful titration due to extensive hepatic metabolism.
Severe:
Contraindicated or use with extreme caution; significant dose reduction may be necessary, monitor closely for adverse effects.
Pharmacology
Mechanism of Action
Diltiazem is a non-dihydropyridine calcium channel blocker that inhibits the influx of extracellular calcium ions across the membranes of myocardial and vascular smooth muscle cells. This leads to relaxation of vascular smooth muscle, resulting in peripheral vasodilation and reduced systemic vascular resistance, thereby lowering blood pressure. In the heart, it decreases myocardial contractility, slows sinoatrial (SA) and atrioventricular (AV) nodal conduction, and prolongs AV nodal refractoriness, leading to a reduction in heart rate and myocardial oxygen demand.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 40-65% (due to extensive first-pass metabolism)
Tmax:
Approximately 10-14 hours (for extended-release formulations)
FoodEffect:
Food may increase or decrease absorption depending on the specific extended-release formulation; Matzim LA can be taken with or without food, but consistency is recommended.
Distribution:
Vd:
Approximately 3-13 L/kg
ProteinBinding:
Approximately 70-80%
CnssPenetration:
Limited
Elimination:
HalfLife:
Approximately 5-10 hours (terminal half-life for extended-release formulations)
Clearance:
Approximately 6-13 mL/min/kg
ExcretionRoute:
Primarily urine (35-65%) and feces (35-65%)
Unchanged:
Less than 5% (in urine)
Pharmacodynamics
OnsetOfAction:
Within 30-60 minutes (for blood pressure reduction with ER formulations)
PeakEffect:
Approximately 2-6 hours (for blood pressure reduction with ER formulations)
DurationOfAction:
24 hours (for once-daily extended-release formulations)
Safety & Warnings
Side Effects
Important Side Effects to Report to Your Doctor Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Slow heartbeat
Abnormal heartbeat that is new or worsening
Worsening heart failure, characterized by:
+ Shortness of breath
+ Significant weight gain
+ Swelling in the arms or legs (if you have a history of heart failure, discuss this with your doctor)
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, which may be life-threatening
+ Symptoms may include:
- Red, swollen, blistered, or peeling skin
- Skin irritation with or without fever
- Red or irritated eyes
- Sores in the mouth, throat, nose, or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. However, if you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Headache
* Feeling dizzy, tired, or weak
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Slow heartbeat
Abnormal heartbeat that is new or worsening
Worsening heart failure, characterized by:
+ Shortness of breath
+ Significant weight gain
+ Swelling in the arms or legs (if you have a history of heart failure, discuss this with your doctor)
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, which may be life-threatening
+ Symptoms may include:
- Red, swollen, blistered, or peeling skin
- Skin irritation with or without fever
- Red or irritated eyes
- Sores in the mouth, throat, nose, or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. However, if you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Headache
* Feeling dizzy, tired, or weak
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or lightheadedness, especially when standing up.
- Fainting spells.
- Very slow heart rate (e.g., feeling your pulse is unusually slow).
- New or worsening swelling in your ankles, feet, or legs.
- Difficulty breathing or shortness of breath.
- Signs of liver problems such as yellowing of the skin or eyes (jaundice), dark urine, persistent nausea or vomiting, or unusual tiredness.
- Severe allergic reaction (rash, itching/swelling, severe dizziness, trouble breathing).
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain types of abnormal heart rhythms, as this medication is not suitable for use with these conditions. If you are unsure, consult your doctor or pharmacist to determine if this medication is safe for you.
Any of the following health conditions: fluid accumulation in the lungs, low blood pressure, or a recent heart attack.
If you are currently taking ivabradine or rifampin, as these medications may interact with this drug.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your existing medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain types of abnormal heart rhythms, as this medication is not suitable for use with these conditions. If you are unsure, consult your doctor or pharmacist to determine if this medication is safe for you.
Any of the following health conditions: fluid accumulation in the lungs, low blood pressure, or a recent heart attack.
If you are currently taking ivabradine or rifampin, as these medications may interact with this drug.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your existing medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and exercise caution when climbing stairs.
As directed by your doctor, regularly monitor your blood pressure and heart rate. You may need to undergo an electrocardiogram (ECG) before initiating treatment and during the course of therapy. Discuss any concerns or questions with your doctor.
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or supplements.
If you consume grapefruit juice or eat grapefruit regularly, discuss this with your doctor. Additionally, talk to your doctor before consuming alcohol while taking this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and exercise caution when climbing stairs.
As directed by your doctor, regularly monitor your blood pressure and heart rate. You may need to undergo an electrocardiogram (ECG) before initiating treatment and during the course of therapy. Discuss any concerns or questions with your doctor.
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or supplements.
If you consume grapefruit juice or eat grapefruit regularly, discuss this with your doctor. Additionally, talk to your doctor before consuming alcohol while taking this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe hypotension (very low blood pressure)
- Profound bradycardia (very slow heart rate)
- AV block (heart block)
- Asystole (cardiac arrest)
- Heart failure
- Cardiogenic shock
- Dizziness
- Confusion
- Lethargy
What to Do:
In case of suspected overdose, seek immediate medical attention or call emergency services. For U.S. residents, call Poison Control at 1-800-222-1222. Management is supportive and may include intravenous fluids, vasopressors (e.g., norepinephrine), atropine for bradycardia, calcium gluconate/chloride, glucagon, and cardiac pacing if necessary.
Drug Interactions
Contraindicated Interactions
- Ivabradine (increased risk of bradycardia and conduction disturbances)
- Dantrolene (IV) (risk of cardiovascular collapse)
Major Interactions
- Beta-blockers (additive negative chronotropic and inotropic effects, increased risk of bradycardia, AV block, and heart failure)
- Digoxin (increased digoxin serum concentrations, risk of toxicity)
- Amiodarone (increased risk of bradycardia, AV block, and myocardial depression)
- Statins (e.g., simvastatin, lovastatin - increased statin concentrations due to CYP3A4 inhibition, increased risk of myopathy/rhabdomyolysis)
- Cyclosporine, Tacrolimus, Sirolimus (increased immunosuppressant levels due to CYP3A4 inhibition)
- Alpha-blockers (e.g., prazosin, doxazosin - additive hypotensive effects)
- Fingolimod (increased risk of bradycardia)
Moderate Interactions
- Other antihypertensives (additive hypotensive effects)
- Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir - increased diltiazem levels)
- Strong CYP3A4 inducers (e.g., rifampin, phenytoin, carbamazepine - decreased diltiazem levels)
- Midazolam, Triazolam (increased benzodiazepine levels due to CYP3A4 inhibition)
- Theophylline (increased theophylline levels)
- Buspirone (increased buspirone levels)
Minor Interactions
- Grapefruit juice (may increase diltiazem levels due to CYP3A4 inhibition, avoid excessive consumption)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing for hypertension/angina management.
Timing: Prior to initiation of therapy.
Heart Rate (HR)
Rationale: To establish baseline and assess for bradycardia, especially given diltiazem's effect on AV nodal conduction.
Timing: Prior to initiation of therapy.
Electrocardiogram (ECG)
Rationale: To assess for pre-existing conduction abnormalities (e.g., AV block, sick sinus syndrome) that may be exacerbated by diltiazem.
Timing: Prior to initiation, especially in patients with cardiac history.
Liver Function Tests (LFTs)
Rationale: Diltiazem is extensively metabolized by the liver; baseline assessment is important, especially in patients with hepatic impairment.
Timing: Prior to initiation, particularly if hepatic impairment is suspected.
Renal Function (BUN, Creatinine)
Rationale: To assess baseline kidney function, as dose adjustments may be considered in severe renal impairment.
Timing: Prior to initiation.
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly (e.g., weekly during titration, then monthly or as clinically indicated)
Target: Individualized based on treatment goals (e.g., <130/80 mmHg for hypertension)
Action Threshold: Persistent hypotension (e.g., systolic <90 mmHg) or inadequate BP control.
Heart Rate (HR)
Frequency: Regularly (e.g., weekly during titration, then monthly or as clinically indicated)
Target: Typically 50-90 bpm (avoiding symptomatic bradycardia)
Action Threshold: Persistent bradycardia (<50 bpm) or symptomatic bradycardia.
Signs/Symptoms of Peripheral Edema
Frequency: At each visit
Target: Absence of significant edema
Action Threshold: Development of new or worsening peripheral edema.
Liver Function Tests (LFTs)
Frequency: Periodically, especially with long-term use or if hepatic impairment is suspected/present.
Target: Within normal limits
Action Threshold: Significant elevation of liver enzymes (e.g., >3x ULN).
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fainting spells (syncope)
- Swelling of ankles, feet, or lower legs (peripheral edema)
- Shortness of breath
- Unusual fatigue or weakness
- Chest pain (if angina is not controlled)
- Palpitations or irregular heartbeat
- Signs of liver dysfunction (e.g., yellowing of skin/eyes, dark urine, persistent nausea/vomiting)
Special Patient Groups
Pregnancy
Diltiazem is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects on the fetus, but there are no adequate and well-controlled studies in pregnant women.
Trimester-Specific Risks:
First Trimester:
Potential for developmental abnormalities observed in animal studies at high doses; human data are limited.
Second Trimester:
Limited human data; generally, risks are considered similar to the first trimester.
Third Trimester:
Potential for effects on fetal heart rate and uterine contractility; caution advised.
Lactation
Diltiazem is excreted into breast milk. The American Academy of Pediatrics considers diltiazem to be compatible with breastfeeding, but caution is advised. Monitor the infant for signs of bradycardia, hypotension, or other adverse effects.
Infant Risk:
Low to moderate risk; monitor for bradycardia, hypotension, and sedation in the infant.
Pediatric Use
Safety and efficacy have not been established in pediatric patients for the treatment of hypertension or angina. Use is generally not recommended.
Geriatric Use
Elderly patients may be more sensitive to the effects of diltiazem, particularly regarding blood pressure lowering and heart rate reduction. Start with lower doses and titrate slowly, monitoring closely for adverse effects such as bradycardia, hypotension, and peripheral edema.
Clinical Information
Clinical Pearls
- Matzim LA is an extended-release formulation designed for once-daily dosing. Emphasize the importance of taking it consistently at the same time each day.
- Advise patients not to crush, chew, or divide the tablets, as this can lead to rapid release of the drug and potential overdose.
- Educate patients about the common side effect of peripheral edema (swelling of ankles/feet) and when to report it.
- Caution patients about potential additive effects when combined with other medications that lower heart rate or blood pressure (e.g., beta-blockers, digoxin).
- Grapefruit juice can increase diltiazem levels; advise patients to avoid or limit its consumption.
- Monitor for signs of bradycardia or AV block, especially in patients with pre-existing conduction abnormalities or those on other rate-lowering agents.
Alternative Therapies
- Other calcium channel blockers (e.g., amlodipine, felodipine, verapamil)
- ACE inhibitors (e.g., lisinopril, enalapril)
- Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
- Beta-blockers (e.g., metoprolol, carvedilol)
- Diuretics (e.g., hydrochlorothiazide, furosemide)
- Nitrates (for angina, e.g., isosorbide mononitrate, nitroglycerin)
Cost & Coverage
Average Cost:
Highly variable per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Typically Tier 1 or 2 for generic formulations; Tier 2 or 3 for brand-name formulations, depending on insurance plan.
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to facilitate prompt and effective treatment.